Those of us who are not of pensionable age cannot remember a time when there was not a National Health Service, but 87-year-old Elinor Corfan, a retired doctor, can speak from experience. In our series marking the 60th anniversary of the NHS, she tells Jo Ind what life was like before there was free healthcare for all.

I want to say immediately I am deeply ashamed and angry when I think of the inequities in the provision of healthcare before the NHS.

I was passionate about the injustice – and still am. I remember a mother saying to me she had to choose between medicine for her sick child or a loaf for her family.

People should know there has been a complete transformation in medical services over the past 60 years.

I was born in Edinburgh in 1921. Since childhood, I always wanted to be a doctor, and was fortunate enough to win a bursary which paid for my fees, books and maintenance over five years, I was happy to enrol in the well-known Edinburgh University Medical School where I studied from 1939 to 1944.

By the time the NHS was founded in 1948, I had worked as a house-officer and then registrar in general medicine, obstetrics gynaecology and paediatrics.

I came to Birmingham when I married in 1950 and worked here as a part-time assistant in general practice for two years.

I can therefore make comparisons – but there is no comparison between things as they are now and as they were then, either in the number and quality of remedies or the system that denied the most needy members of society good quality health care. There were great injustices perpetuated until 1948.

Until the end of the war penicillin was reserved for the Armed Forces. It became available to the public on prescription in late 1946, but who could afford it?

I remember a time when a young man was admitted to hospital. He was not in the Armed Forces and was not entitled to penicillin. He was dying before our eyes.

Fortunately my chief managed to get a small supply and it was my privilege to inject this crude musty-smelling yellow liquid into his muscles and see his recovery.

This made me hope for the day when we could prescribe to all.

Before the NHS there were different standards of healthcare for different social classes.

Those who could afford it paid for doctor’s fees and medicines. Some were covered by the 1911 National Insurance Act. They paid a few pennies a week and were treated free. This system was “on the panel.”

But the panel was only available to those between 16 and 70 and in work.

Millions were excluded – women not at work, children, the elderly, the unemployed – the most vulnerable and needy members of society had no decent healthcare.

I was morally outraged.

I joined the Socialist Medical Association – disbanded in 1993 – which for many years advocated a new system of medical care, free from cradle to grave.

There was provision of a sort at the People’s Dispensary, a primary health care facility for those who could not afford a doctor. But it was a very inadequate service. Run by an elderly GP, it was manned by fourth and fifth-year medical students ignorant, gauche and completely inexperienced.

We would go in pairs when a call came for a “doctor,” not because it was dangerous, but because we needed mutual support. I remember one time I went to examine a sick child in a bed under a broken window stuffed with rags. As I leant over I put a hand against the dilapidated damp wall and to my horror my hand went right through.

I must admit I cringe with embarrassment when I think of our medical short-comings. I only hope we did no harm.

Nye Bevan, the founder of the NHS, used to call women, ‘the silent majority’ because they were the helpless victims of pre-NHS medicine. Without free contraception, many were exhausted by frequent, sometimes annual pregnancies.

Not being on the panel they had only inferior primary care and stoically endured chronic ill-health. Antenatal clinics were run by the local authority, but, overwhelmed by lassitude and hardship, the women who most needed supervision in pregnancy were unable to attend.

Complications which required admission to maternity hospital went undiagnosed.

The most disadvantaged were lost to the system. They could not afford a doctor when they went into labour. Obstetric care was by inexperienced fourth-year medical students, fortunately supervised by trained midwives.

When a call came, we would walk to the home, always in squalid slums, through the pitch-black war-time night, carrying our equipment, hoping there would not be an air-raid.

We never knew what we would encounter and there were terrifying emergencies – massive haemorrhage, foetal distress, malpresentations, such as breech. Once the midwife called out: “Oh, my God, there are two heads here” and we delivered undiagnosed twins.

There was no phone, no ambulance. Every second was vital and we just had to do our best. This was pre-NHS obstetrics for the poor.

I am haunted by these memories, when labour was so dangerous both to mother and child. Again, I only I hope we did no harm.On one occasion, we found ourselves on the sixth floor of a tenement in the High Street.

The home was a large room, but it had to accommodate the entire family. There was a heap of coal in the corner and a single cold-water tap outside on the landing shared between several families.

Such deplorable living conditions were not uncommon. The high infant and maternal mortality rate does not surprise me. My fellow students did not always share my concerns about the wider social issues.

The men especially had to be concerned with studies. They were privileged in being exempt from military service, but if they failed an exam twice, especially at crucial stages during the war, they were called up immediately.

In 1940, in the Battle of Britain, they were recruited as rear-gunners in the RAF and saw active service after brief training. The life expectancy of a rear-gunner was about six weeks. Two of my friends lost their lives. You can’t blame the Government. They were fit young men. How could they justify their privileged existence if they didn’t work?

In 1944, my final year, I was at last able to interest people in the proposed NHS.

I organised a seminar, to enlighten us and get the view of our elders and betters. More than 500 students attended.

Like their mothers, it was also the children of the poor who suffered most.

In the 1930s and 1940s, when, except for smallpox, there was no immunisation, infectious diseases were widespread and were the scourge of childhood.

Diphtheria, whooping cough, scarlet fever and measles took a terrible toll, especially among poorer children whose resistance was lowered by malnutrition and who were prone to develop complications such as encephalitis, nephritis and chronic ear infections, leading to longstanding ill-health. There was a significant mortality rate. Fortunate children such as myself had mild attacks and were nursed at home, but those less fortunate were confined to the “Fever Hospital” for at least six weeks.

Visiting was either not allowed or very limited, a traumatic experience for a bewildered young sick child. This was established practice, no matter how inhumane it seems.

As children from underprivileged families were more susceptible to infection, they suffered multiple hospital admissions and lost not only their health but their education.

Many were further handicapped by unrecognised deafness and visual defects.

Returning to school, they had fallen behind classmates, couldn’t see the blackboard, couldn’t hear the teacher. Their subsequent lack of education meant they were condemned as adults to low-level, poorly paid jobs, if any, perpetuating the cycle of deprivation. Working in a Liverpool children’s hospital in 1948 was a chastening and depressing experience.

Faced with so many children suffering from diseases of poverty, I felt utterly helpless.

Besides the usual childhood illnesses, we had patients with conditions never seen today such as rheumatic fever, with fearsome effects on the heart, nephritis leading to renal failure, and osteomyelitis, a chronic bone infection resistant to treatment, all necessitating prolonged hospital stays.

One feared for the future of these children if and when they recovered.

Most harrowing were those baby wards reserved for children with acute gastroenteritis, often due to environmental causes like poor hygiene or artificial feeding. These infants would be admitted in extremis, practically moribund, severely dehydrated.Whatever the cause, they were medical emergencies needing urgent hydration with intravenous drips. During an epidemic, it seemed I was doing nothing else day and night but resuscitating mortally ill infants.

I was much too busy to notice the famous appointed day on 5 July 1948 when the NHS began.

Not surprisingly we were unable to save all the children and it was my painful responsibility to break the news to bereaved parents, a duty which never became easier.

Our first act every day was to sign death certificates. I felt humbled by our failures.

Coming into general practice in 1950, was a heartening experience. I could see how the new regime was working and patients were touchingly grateful. Long gone was the feeling of hopelessness, of being impotent. We could prescribe freely.

If I was worried about patients, I could make as many home visits as necessary without having to consider whether they could afford it.

The NHS encouraged an explosion in research by pharmaceutical companies.

New drugs and technology would have come with time, but research and development is enormously expensive.

With the certainty of a profitable market in the NHS, pharmaceutical companies have created thousands of new and effective remedies which have transformed the therapeutic scene.

In the 1950s, I visited an elderly man with advanced Parkinson’s who had been bed-ridden for years, nursed by a devoted wife.I prescribed the new costly drugs, which slowly became effective. It caused quite a sensation in the neighbourhood when he first walked out of his door. I felt exhilarated by this freedom to fulfil my obligations as a doctor.